株洲地区80例新型冠状病毒肺炎患者临床特征分析

 

目的 分析新型冠状病毒肺炎（COVID-19）患者的临床和流行病学特征，以进一步提高对该病的认识。方法 对2020年1月20日-2月27日株洲市80例确诊为COVID-19住院患者的临床资料进行回顾性分析，包括流行病学情况、临床特征、治疗及转归情况，比较轻型和普通型组、重型和危重型组患者的临床特点。结果 80例 确诊患者中，湖北疫区来源22例（27.5%），非湖北疫区来源58例（72.5%），其中有明确接触传染源者45例（56.3%），无明确接触史者13例（16.3%）。聚集性疫情共17起，涉及病例55例，湖北输入性聚集疫情4起，病例9例，其中家庭聚集3起；本地聚集性疫情13起，病例46例，家庭聚集10起，社交聚集2起，朋友聚餐1起。80例患者中位年龄为47.5岁；男女比例为1 ∶1；22例患者（27.5%）合并基础疾病，居前3位的基础疾病依次为高血压病、糖尿病、冠心病；轻型病例8例（10.0%），普通型55例（68.8%），重型11例（13.8%），危重型6例（7.5%）。主要临床症状为发热、咳嗽咳痰、乏力、头痛、肌肉酸痛、腹泻。与轻型和普通型组患者相比，重型和危重型组患者年龄更大，糖尿病、高血压病比例更高，发生呼吸困难、呼吸频率>24次/分比例高，差异均有统计学意义（均P<0.05）。白细胞数正常或减低者78例（97.5%），淋巴细胞计数<1.0×10⁹/L者20例（25.0%）；重型和危重型组患者的淋巴细胞计数、淋巴细胞百分比、血红蛋白、清蛋白均低于轻型和普通型组患者（均P<0.05），多项血液指标比较差异有统计学意义。9例（11.3%）患者无肺炎表现，15例（18.8%）患者肺部单侧受累，56例（70.0%）患者肺部双侧受累，17例（100.0%）重型、危重型患者均为双肺受累。结论 新型冠状病毒感染呈家族聚集性发病，年龄大、合并基础疾病在重症和危重症患者中所占比例较高，大多数重型患者淋巴细胞计数显著减少，可作为临床预警指标。

Clinical characteristics of 80 patients with COVID-19 in Zhuzhou City

Objective To analyze clinical and epidemiological characteristics of patients with coronavirus disease 2019 (COVID-19), further enhance the understanding on COVID-19. Methods Clinical data of 80 patients who were confirmed with COVID-19 in Zhuzhou City from January 20 to February 27, 2020 were analyzed retrospectively, including epidemiological condition, clinical characteristics, treatment and outcome. Clinical characteristics of patients in mild, common, severe and critically severe groups were compared. Results Of 80 confirmed patients, 22 (27.5%) were from Hubei epidemic areas, 58 (72.5%) were not from Hubei epidemic areas, 45(56.3%) of whom definitely contacted with infection sources and 13 (16.3%) had no definite contact history. There were 17 clustering epidemic involving 55 cases, 4 clustering epidemic imported from Hubei involving 9 cases, including 3 familial clustering; 13 local clustering epidemic involving 46 cases, including 10 familial clustering, 2 popular social gathering, and 1 friends'' dinner gathering. The median age of 80 patients was 47.5 years; ratio of male to female was 1:1; 22 patients (27.5%) complicated with underlying diseases, the top three underlying diseases were hypertension, diabetes and coronary heart disease; there were 8(10.0%) mild cases, 55(68.8%) common cases, 11(13.8%) severe cases, and 6(7.5%) critically severe cases. The main clinical symptoms were fever, cough, expectoration, fatigue, headache, muscle ache and diarrhea. Compared with patients in mild and common groups, patients in severe and critically severe groups were older, with a higher proportion of diabetes and hypertension, and a higher proportion of dyspnea and respiratory frequency>24 times/minute, differences were all statistically significant(all P<0.05). 78 patients (97.5%) had normal or decreased white blood cell count, 20 (25.0%) had lymphocyte count <1.0×10⁹/L; lymphocyte count, lymphocyte percentage, hemoglobin and albumin in patients in severe and critically severe groups were all lower than those in mild and common groups (all P<0.05), differences in several blood indicators were all statistically significant. Nine patients(11.3%) had no pneumonia manifestations, 15 patients (18.8%) had unilateral lung involvement, 56 patients (70.0%) had bilateral lung involvement, all 17 patients (100.0%) in severe and critically severe groups had bilateral lung involvement. Conclusion Novel coronavirus(2019-nCoV) infection presents familial clustering, the proportion of older age and underlying diseases is higher in severe and critically severe groups, lymphocyte count of most severe patients decreased significantly, which can be used as a clinical early warning indicator.